Eastern Europe is an emerging epicenter of injection drug use and HIV infection, among women. Within Eastern Europe, the Republic of Georgia is one of the last countries where an HIV epidemic can still be averted. This proposal responds to RFA-DA-10-008 International Research Collaborations on HIV/AIDS and Drug Use by building on the successful collaboration among US and Eastern European investigators from the Republic of Georgia and Russia. Recent data from Georgia's neighbor, Russia, reported 59% of IDU women HIV seropositive; this is a threat that looms over Georgia. Understanding the risk factors that operate in Russia that drive this epidemic may help forestall such a catastrophe in Georgia. As such, this proposal directly responds to the Eastern European Region RFA-specific question of How can drug abuse treatment interventions be integrated with established HIV prevention approaches to optimize their combined effectiveness? Injection drug using (IDU) Georgian women show prevalence rates of 2% for HIV and 25% for hepatitis C (HCV). The low prevalence of HIV in Georgian women provides an important window of opportunity to intervene and avoid the possibility of an HIV epidemic. In Georgia, women's expected subordination to men makes women vulnerable to HIV/HCV infection. The proposed study will proceed by meeting four sequential aims. Aim 1. Explore drug use (e.g., types and patterns), HIV and HCV injection and sexual risk behaviors, comorbid conditions (e.g., interpersonal violence, comorbid psychiatric disorders), and treatment barriers and experiences (e.g., gender discrimination) among n=54 IDU Georgian women. Aim 2. Identify from n=34 treatment providers their practices and perceptions regarding IDU women in the current Georgian drug-treatment system. Aim 3. We will adapt and pretest both a drug abuse treatment approach of Reinforcement-Based Treatment (RBT) that integrates the evidence based Women's Co-Op HIV prevention and a case management approach for IDU Georgian women. This aim includes n=16 IDU women and n=16 providers in separate focus groups followed by n=20 IDU women completing pretesting. Aim 4. In a small- scale randomized trial (n=128), determine the feasibility and initial efficacy of our Georgian RBT model relative to a case management model in terms of their respective impacts on the frequency of unprotected sexual acts and syringe sharing at post-treatment and 3-month post-treatment follow-up. The public health impact of the proposed project is far-reaching. Taken to scale, our Georgian RBT treatment model holds the promise not only to lessen the possibility of an HIV epidemic and slow the increase in the HCV transmission rate in Georgia, but also to strongly influence the development of women-focused drug abuse intervention models for treatment tailoring and dissemination in other nations. PUBLIC HEALTH RELEVANCE: This is an opportune time for United States, Republic of Georgia, and Russian collaborators to further identify the patterns of drug use and cultural contexts of risks in order to adapt and test a comprehensive treatment model for women injection drug users to avert an HIV epidemic and further increases in HCV in the Republic of Georgia.